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7.01.2010

Boardwalks and Home Births

I met you on the boardwalk, a beautifully bronzed burst of sunshine adorned with sparkles, bright yellow, and black flowers that flowed around your barely rounded belly. Your tangled mass of thick, wavy, auburn hair reached down toward your elbows and your smile was as brilliant white as the sun-bleached wicker chairs dotting the deck.

A square jaw jutted forward as you pressed your face toward the wind as you laughed gently at something that was said between your lover and you. Your partner lovingly wrapped his hands around you from behind, caressing your abdomen, before dashing off into the crowd.

I edged closer.

"My, are you ever beautiful! I love a pregnant woman, so full of life!"

You blushed darker bronze and murmured a thanks while outlining the contours of your baby with your palms.

I introduced myself and told you my calling. Instantly, your eyes began to sparkle and dance like the sunlight on the nearby cresting waves, "Oooh! I wanted to have a home birth so badly!" you exclaimed.

"What's holding you back?"

"My partner/I thought it was too risky", "I will definitely look into it further for future pregnancies, but, with my first and because I don't know what to expect, I think the hospital is a better choice", "It seems a little too hippy for me", "My partner is not comfortable with it", "my doctor is just fine and its only one day, right?".

You named your reasons, and I listened quietly, offering only a gentle nod of encouragement to continue. When you had exhausted all of your worries, you looked at me anxiously, apologetically. Your partner appeared as if a mirage and wrapped his sheltering arms around you, moving you away from me and further down the boardwalk.

I grasped your hand in goodbye, pressing my card, and this blog address, into your palm. "I wish you all the luck in the world. You are an amazingly beautiful, strong woman who is doing a good work to bring this beautiful life into the world!"

And you were gone.

I hope you have found your way here. Because I had so much I wanted to tell you!

A midwife and a doctor view birth so much differently! There is a wonderful source of information on what to ask your care provider to find out if they are truly Mother-Friendly, and I invite you to read it here.

Additionally, here is a pretty concise outline of the differences between a midwife and a medical model of care.

Midwives Model of Care

Medical Model of Care

Definition:

Definition:

• Birth is a social event, a normal part of a woman's life.• Birth is the work of the woman and her family.• The woman is a person experiencing a life-transforming event.

• Childbirth is a potentially pathological process.• Birth is the work of doctors, nurses, midwives and other experts.• The woman is a patient.

Definition:

Definition:

• Home or other familiar surroundings.• Informal system of care.

• Hospital, unfamiliar territory to the woman• Bueaucratic, hierarchical system of care

Definition:

Definition:

• See birth as a holistic process• Shared decision-making between caregivers and birthing woman• No class distinction between birthing women and caregivers• Equal relationship• Information shared with an attitude of personal caring.• Longer, more in-depth prenatal visits• Often strong emotional support• Familiar language and imagery used• Awareness of spiritual significance of birth• Believes in integrity of birth, uses technology if appropriate and proven

• Trained to focus on the medical aspects of birth• "Professional" care that is authoritarian• Often a class distinction between obstetrician and patients• Dominant-subordinate relationship• Information about health, disease and degree of risk not shared with the patient adequately.• Brief, depersonalized care• Little emotional support• Use of medical language• Spiritual aspects of birth are ignored or treated as embarrassing• Values technology, often without proof that it improves birth outcome

No matter how natural of a birth you have in a hospital setting, it will never even come close to a home birth. Home births are different on so many different levels than simple surroundings.

"My partner/I thought it was too risky"There have been many studies throughout the years that have found that home birth is as safe, if not safer, for healthy, low-risk women, as hospital birth. Most recently, a Canadian study has shown these same findings, once again. Home birth midwives will, very often, carry oxygen, and all carry homeopathics as well as are trained in lifesaving CPR and first-aid.

Home birth midwives are experts in normal, natural childbirth. Because they are experts in normal pregnancy and birth, they will see deviations from normal and natural pregnancy and labor/birth early on, be able to assess these variations, and take immediate and early precautionary measures to ensure your safety... this is part of the reason why home birth is so safe.

If your midwife were to see something that did not match normal and natural, she would be able to attempt to get you back to normal and natural before it became an emergency and, if she couldn't, she would be able to transfer you to appropriate care. Home births have come a long way from ripping up bedsheets and boiling water.

"I will definitely look into it further for future pregnancies, but, with my first and because I don't know what to expect, I think the hospital is a better choice"This particular reason is like a punch to the midsection. There is a large body of women who choose home birth for their second birth because they had a horrible experience with their hospital birth. If you are considering a home birth, your first birth is a great birth to start with - you cannot go back and redo your first birth, and that first birth can impact your options, emotional health and wellbeing, and even fertility of future pregnancies/births.

Some women, by the end of their labor, believe that their doctor/hospital has saved them from a bad outcome, when, in actuality, the hospital or doctor (procedure that they performed) caused the risks that they ended up needing to save you from. But, the perception that is given is that a woman is so thankful that they were in the hospital and are glad that they didn't have a home birth because they 'needed' this or that intervention.

Other women end up with unnecessary cesareans and find it hard to find a homebirth midwife or hospital based doctor who will take her on for a vaginal birth with subsequent pregnancies and births. I am sure you have heard the saying 'there is no time like the present'.

Bottom line, THIS pregnancy and birth is the best one to pursue a home birth for.

"It seems a little too hippy for me"The wonderful thing about midwifery going mainstream in the last 20 years is that you have all types of midwives now practicing. There are more traditional midwives, as well as more modern midwives. This allows for families to find the right type of midwife to fit their families needs.

I also know midwives who wear high heels, highlight their hair, like cabernet sauvignon and sushi, and have a more urban feel.

And most of the midwives I know fall somewhere in-between. The stereotypical 70's midwife is not the only option anymore, but the continuity of care, the midwifery model, will remain constant no matter whom you choose.

"My partner is not comfortable with it"Not all partners are men, and not all partners fit this stereotype, but the majority of male partners are not comfortable with home birth at first. They usually don't research and read as much and tend to follow the paternal medical suit more readily.

That said, if you can simply get your partner to go to an initial interview/consultation with a home birth midwife and present it as an opportunity for your partner to ask whatever questions they might have of the midwife, this can, oftentimes, dispel fear, uncertainty, and incorrect stereotypes and assumptions that they might have about home birth and midwives. Oftentimes, just one consultation is all it takes to get a partner to start seriously considering a home birth.

Here and here are two different examples of the types of interview questions you might ask at an initial consult.

And finally, when it comes down to it, although it is always best to have both of you in agreement over your birth options, it is your birth and body, ultimately, it should be your comfort level and decision on where and with whom to birth.

"My doctor is just fine and its only one day, right?"I know lots of good doctors, I know some 'just fine' docs, and many bad doctors. Not bad at what they do, but bad at taking care of a woman and babies needs and holistic health.

There are doctors who have great bedside personalities, but who are not good doctors. There are doctors who make you feel 'taken care of', but don't shoot straight with you about your options... or disguise your options as necessities so that you don't have true options. And there are doctors who, when you are at your most vulnerable (labor and birth) will 'not allow you' so many things previously promised. It is necessary to more than LIKE your doctor... you must trust him/her with your holistic health and life, and that of your unborn baby. If you don't, you really truly should look for another care provider.

And let's not forget that the average first time labor is around 16 hours. This is average. Some women labor for a few days, some for a few minutes. Beyond the actual laboring time, your birth experience will last with you for much, MUCH longer.. in fact, your whole life. So, if you think it is 'just one day', think again.

My heartfelt desire is for you to remember this moment, which will stick with you for the rest of your life, with joy, trust, love, and fondness. Please make sure that you can trust your care provider for that.

As Dr. Biter said in a recent interview,

They don't even know the difference between natural birth and a vaginal birth. They think that, just because a baby is born out of a vagina that that is a natural birth.

But a natural birth is an unmedicated birth, a birth that is honored, where women and their partners are respected, and where that little buddy comes into this world in a solemn sacred moment. That's what a natural birth is!

There are additional great resources out there that will help you to work through other scenarios that you might encounter to help you make the best choice for you and, hopefully, feel secure in choosing a home birth for your first, beautiful, birthing time.

8 comments:

Oh my goodness, I just love your story. You painted such a wonderful image in my mind. I've debated between home birth and birthing center birth for a while, and think I'll ultimately choose the birthing center, mostly for the fact that it's got everything I might need in one room, plus I don't have to worry about anyone having to clean up my house after baby arrives (tub, supplies, etc.).

I'd love to hear your thoughts or see a post like this about birthing centers.

Beautifully said, Nicole! And your description of the boardwalk encounter with this lovely mama was so poignant...I could almost picture it! It's so challenging, isn't it, to meet a woman in such a situation. If only you could sit down with her over a cup of coffee and listen and answer all her questions. But the words you left her with as she was leaving were so encouraging! Thanks for reminding all of us working in childbirth to love mothers without abandon. :)

As a doula, I hear these reasons all the time. And then these wonem stay with their OBs and end up with a horrible births. To all the pregnant ladies interested in homebirth out there:

Start by just interviewing a few midwives and asking questions! It can't hurt. Hospitals offer medicalized, demoralizing "birth" experiences. If you make it out with a vaginal birth, you are lucky. Homebirths, on the other hand, are safe, empowering, family-centered, and fulfilling.

I have seen it both ways as a doula, and done it both ways myself. Homebirth is the way to go.

Yes! Thank you! Having moved to a new town recently I am continually in these situations with mamas-to-be. Sometimes I don't mention that I am a midwife because honestly holding up the 'birth talk' kaleidoscope with someone can be so emotionally draining. But you do it, because, well, you love women and you want them to have the most joyous, autonomous, physiologic experience as possible.

You start the conversation, and open yourself up to all that the mother is thinking and feeling, sending her your love and compassion and hoping she'll later reflect on some little morsel of the conversation.

So often I think the women who intellectually want all the perceived benefits of homebirth, but who can't take the step emotionally (or vice versa) truly don't know what they're signing up for. Particularly if they have a care provider who is invested in massaging their concerns about interventions etc without being clear about the realities of their protocols and standard operating procedures. So many first time moms really *don't* know what they're getting into when they sign up with their OB -- until their third trimester when some of the pieces start coming together.

Thank you! Thank you for writing this. I am a L&D nurse and have the privilege of working with both midwives and OBs. So I get to witness both models of care at work. After 2 hospital births and working for 9yrs, I decided to have my 3rd child at home. It was the most amazing experience! I truly hate that only 1% of births occur at home. I will definitely share this post with others.